Asbestos project notification form, Corona NY, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) ATC NYSDECPermit# 1A-371 Tel.# (631 )924-505n 28. Asbestos Hauler

Disposal Sites) Southern Alleghenies Disposal l Svc Road 3 BOX 310 va i 1 & yiew Hollsopple PA 15935 of a (Item a through 0 requires filing of this form with NYC Department of iuildings) 27. This asbestos abatement Is part b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ RenovatlonlAlteration a) ❑ Demolition Asbestos Containing Dust e) ❑ Fireproofing Replacement O!Other(Desc1IbeL

28. TYPE OF ABATEMENT (Check all appropriate boxes) py E]CClean up ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ~/ EX Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Appli cation 4 q11 .1/ 30. LOCATIONS OF ABATEMENT DESCRIPTION OF WORK BEING DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM CONTAINING ACM PERFORMED Floor(s) OF FLOOR SkiI~JARE IJJNEIT►R (y, nndrq ~ 'e. (e.~ f. (a•4 Pk" i0. oein . O sm

cle ning f R of 3,0 0 Cleaning of ACM Roof Entire

Federal. complete to the best of my knowledge. I am familiar with 31. 1 hereby declare that the information provided herein is true and work. State and NYC laws and regulations applicable to asbestos related

J.C. Brode ick & 1 2 Ban nterior 192 Branch Interior Associates Prot Nine ,rp,W►owned Pnn sma of estos Contractor Print Nano of Air Mans

(cL' 'e+ oil! sgnature ___

sgnature '9^ilure

i Date Date

performance of abatement activity occurs. I am responsible for the 32. 1 understand that as the owner of a building where asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance with the Asbestos asbestos project. I hereby declare that I have authorized the monitor who is completely Independent of all parties involved in the filing of this notification for the work specified herein. ' O r I hMr-,5 (~1EI5dt~ Print Name of owner Signature Date

AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING

Asbestos not be lawfully avotceo or The V2oet

NYC-WTC 000109631